| Department File Number : | M201573161 |
| Claim Number : | SAM-IG-005061 |
| Date Submitted : | 1/9/2015 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| SAMARITAN RISK RETENTION GROUP, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 20-3433505 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | NANCY | CARR | |||
| Street Address | |||||
| 11440 SW 88th STREET | |||||
| City | State | Zip | |||
| MIAMI | FL | 33176 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (305) 274 - 4070 | (305) 274 - 2701 | carol.lobacz@nccrms.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | John | W | Uribe | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1150 Campo Sano Avenue | ||||
| City | State | Zip Code | County | ||
| Coral Gables | FL | 33146 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| SPL1032 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME31945 | Surgery - Orthopedic | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Dade | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| HEALTHSOUTH DOCTORS' HOSPITAL | 100020 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 4/4/2011 | 8/9/2011 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Chronic severe hemophilic arthropathy of the right shoulder. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Right shoulder partial resurfacing during which procedure the glenoid wall fractured due to significant softening and erosion, requiring build-up of the glenoid wit cement prior to placement of the hemicap prosthesis | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| There was no misdiagnosis made of this patient | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Extra-articular cement fragments allegedly resulting in restricted range of motion and pain. This case was settled without an admission of liability an in order to avoid protracted litigation. | |||||
| Severity Of Injury | |||||
| Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 3/4/2013 | 13-07592 CA 10 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Dade | 10/16/2014 | ||||
| Other Defendants Involved in this Claim | |||||
| Coral Gables Specialty Physicians, LLC | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference. | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 9/25/2014 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $105,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $116,560 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $29,713 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $105,000 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| Not applicable. | |||||||||||||||||||||
| Updates | |
| No updates found. |
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Does Dr. JOHN W URIBE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JOHN W URIBE, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).